In part 1 of my Type 1 Diabetes and the Gut series, I went over:
- The gut’s primary functions
- Why gastrointestinal (GI) microbe balance and diversity are vital for gut health
- How these compromises may impair the immune system along with promoting type 1 diabetes
Throughout the rest of these posts, I’ll discuss the 5 most common variables that typically promote gut dysbiosis and its influence on type 1 diabetes and blood sugar mismanagement.
In this post, get ready to learn:
- How the standard American diet may influence gut dysfunction and its effect on blood sugar stability
- The low-carb diet flaw and a solution that may benefit gut and diabetic health
- How diabetic and gut health may benefit with prebiotics, probiotics, and short-chain fatty acids
Let’s go!
What Specific Factors Affect Gut Health?
This is a wide net of a question that will take some time to answer appropriately in the context of this discussion.
Remember that the majority of intestinal and immune compromise will likely begin with gut dysfunction, specifically gut dysbiosis.
Before I go over these common factors that influence dysbiosis, let’s first review a lot of gastrointestinal (GI) words with similar meanings in this series of posts.
Now, let’s review a recent article that discusses the findings of the oldest, most-preserved 50,000-year-old neanderthal poop to date (1).
Microbiome and diversity compositions are usually measured from poop samples.
When asked about the neanderthal’s microbiome results compared to findings in present populations’ intestinal flora throughout the world, the researchers noted,
Several factors typically influence our gut flora, but these 5 variables are the most common culprits we’ll focus on throughout this series of posts:
- Diet
- Over-the-counter cedications
- Chronic stress
- Chronic infections
- Physical activity
- Genetic & environmental triggers – which one typically has more influence over type 1 diabetes? (Bonus)
This post will begin with diet.
The Western Diet & its Lack of Fiber
Diet is one of the most important health triggers given its constant effects on not only blood sugars and insulin demand, but also gut and immune responses (2, 3).
The American Medical Association recommends 25 -30 grams of fiber per day. But the actual daily intake among those in the US and Europe is approximately only 15 g a day.
Meanwhile, current hunter-gatherers, such as the Hazda of Tanzania, consume an average of 100 – 150 g of fiber per day (4).
Another paper noted that modern hunter-gatherer groups consume hundreds of different species of fruits and vegetables, each (5)!
Based on popular foods consumed in the US, 150 g of fiber is equivalent to each of the following:
Mass-produced foods like these make up a good portion of the Western or Standard American Diet (SAD).
Researchers found that the Hazda population had a much more uniquely diverse microbiome due to their lifestyle of hunting and gathering their foods of wild animals and diverse plants from neighboring forests.
They concluded that the further away diets are from typical Western foods, the more diverse gut microbes will likely become.
Remember the two factors that enrich gut health that we spoke about in part 1?
Sadly, there is plenty of research citing the negative impact the Western Diet can have on the microbiome, which in turn likely effects diabetic management as you’ll soon see.
This particular study speculates the percentage of junk foods, like sodas and highly palatable snacks, eaten in some countries are as followed (6):
France: 29.1%
Australia: 42%
USA: 57.9%
Not only that, but they also found in animal and human studies significant changes in microbiota integrity given the increase of junk foods consumed that are riddled with food additives, natural flavors, and artificial sweeteners.
These additional filler ingredients help to create a more palatable product for consumption that also produces a longer shelf-life at cheaper costs to minimize profit loss to the food manufacturers (7).
These foods are normally energy/calorically dense but contain minimal nutrients that the body needs.
As a good template to start with, if you can’t pronounce, let alone understand the ingredients of what’s being consumed, it’s typically safer to limit or avoid eating those particular items altogether.
Eating predominantly whole foods, if medically tolerated, normally begins to resolve many health problems.
Fibers That Benefit the Gut
From the variety of fibers known, our focus will be on fermentable fibers.
Normally, the more fermentable the fiber, the greater its ability to help the gut and overall health.
Of the fermentable fibers that exist, the two that we’ll briefly go over are:
- Soluble fibers
- Resistant starches
First, let’s go over why fermentable fibers may be so helpful.
Below are some dietary sources where one can get fermentable fibers:
One animal study even observed fermentable fibers to help prevent and manage type 1 diabetes in rats (8).
Soluble Fiber
Some dietary sources of soluble fiber include starchy tubers, squash, broccoli, and peeled fruits, i.e. avocados, pears, and apples.
Given that many dietary fibers also spike blood glucose levels, there are times when supplementary forms may be more beneficial to add among those with gut and blood sugar distress.
This is especially true if one is on a low-carb/high-protein diet as many of the beneficial fibers will likely not be consumed due to their blood-sugar-spiking potential.
Given that most soluble fibers attract water, this makes them unique with potentially added benefits.
Most soluble fiber supplements also have associations with better blood glucose, cholesterol, triglyceride, body weight, and satiety regulation, in addition to increases in insulin sensitivity (9, 10, 11, 12).
Some to consider with your doctor are:
(Dr. Mo has no affiliation with NOW supplements.)
Now, let’s move on to another fermentable fiber called resistant starch.
Resistant Starch
Just so that everyone is aware, there is a significantly larger population of microbes that reside in the colon in comparison to any other organ in the gut.
This is the reason why bowel issues typically arise when gut dysbiosis is present.
However, it’s not uncommon to see immune dysfunction present with gut dysbiosis, but without GI symptoms.
For example, I have celiac disease but no endocrinologist has ever tested me for it due to me never having expressed any gut symptoms.
Upon my first interaction with a functional medicine provider, she checked and confirmed I was, indeed, intolerant to gluten.
Resistant starch is an insoluble fiber that is not digested in the small intestine or stomach. This is why it’s able to reach the colon untouched.
While in the colon, resistant starch has been shown to single out and stimulate the growth of good gut bugs, such as Bifidobacteria and Lactobacillus, while also increasing short-chain fatty acid production (13, 14).
As a result, the SCFAs are associated with microbe diversity and balance, along with assisting in immune function (15).
There’s also evidence of resistant starch helping out with mineral absorption and decreasing body weight (16, 17).
A Low-Carb Diet Flaw & Possible Solution
There are four different types of resistant starches, but the only digestible one is type 3 resistant starch.
Type 3s are formed when foods like baked potatoes, green plantains, or rice are cooked, then cooled to eat.
When cooked, the starch changes to a digestible form, but when cooled, it goes back to being undigestible or resistant.
The Low-Carb Flaw Among Type 1 Diabetics
A low-carb diet regimen among type 1 diabetics has been shown to better maintain more stable and predictable blood sugars among them (18, 19).
As previously mentioned, many of these popular, good fibers have a tendency to cause blood sugar spikes.
As a result, some of these fibers will go against many of the low-carb principles and blood sugar benefits.
Not to mention, if you’re like me and don’t respond well to the dietary resistant starches!
As a result, the diversity of fibers is reduced, not to mention the likely benefits from consuming them for not only your gut but diabetic health, as well.
Not all is lost, though!
A Low-Carb Solution for Missing Fibers
There are more fermentable fibers that may be consumed in supplement form. We’ve already gone over some soluble fiber options.
These resistant starch supplements may be also be worth considering while amplifying low-carb dieting benefits.
Instructions for these resistant starch supplements are to mix them in cool liquids or foods to consume preferably prior to your meal as research has suggested this to lessen blood sugar spikes (20).
It is recommended to start out really slowly, maybe 1/4 of a teaspoon per day due to strong gut symptoms that may respond. If your gut is reacting well to it, work up to 2 – 4 tablespoons per day.
The resistant starches I use are potato starch, green banana starch, and green plantain starch.
So, if these fibers may help our gut and immune function, can you imagine the trouble our bodies may go through without them?
But with widespread illnesses plaguing the world with no signs of slowing down, unfortunately, you don’t have to stretch your imagination too far.
SCFA deficiency has been suggested to increase type 2 diabetes risk, gut dysbiosis, and poor blood glucose control (21). But with resistant starch present, it may help against these effects.
Type 1 diabetics now have potential solution that may not only give them better blood sugar management control but might also provide their gut with the nutrients it needs to further influence overall health benefits.
Next, let’s review another benefit of fermentable fibers and touch on fermented foods.
Prebiotics & Probiotics
One of the biggest differences between current and ancestral diets is the amount of fiber consumed daily.
These fibers are commonly found in fruits, vegetables, plants, nuts, and seeds.
These fibers either act as prebiotics or probiotics that collectively help to populate and diversify beneficial microbes in the gut, depending on the variety of fibers being consumed.
So, which of the two usually has a greater impact?
Typically, prebiotics are more beneficial in comparison to probiotics.
The reason is because prebiotics act as gut bug “food,” which enable microbes to grow in numbers.
Probiotics, on the other hand, are considered to be the actual “good gut bugs,” themselves.
As soon as probiotic intake stops, these helpful microbes won’t stick around without prebiotics to feed them in order to grow and multiply.
It’s not to say that probiotics aren’t beneficial, though.
They are, but when taken with qualitative prebiotics health benefits usually increase.
There are exceptions, however, that I will go over at the end of this post in my disclaimer.
When both are properly used, their saturated gut residency usually allows the GI system to absorb the plentiful nutrients we are (hopefully) consuming and effectively battle off toxins and pathogens whenever they choose to test our gut barrier, while also minimizing the growth of bad gut bugs.
One of the more popular energy sources that gut microbes consume are short-chain fatty acids, which prebiotics also provide plenty of (22).
Let’s talk about the benefits that SCFAs typically provide to the general population and diabetics.
General Short-Chain Fatty Acid Benefits
One of the main benefits of consuming all these fibers is that they promote SCFA production, which has been shown to strengthen the gut barrier, reduce gut inflammation, and better stabilize blood sugars while assisting with immune function (23, 24).
The evidence of SCFAs and colon benefits are quite numerous, as well.
Benefits may also extend to brain health, irritable bowel disease (IBD), and colon cancer prevention (25, 26, 27, 28, 29).
Research has also suggested improved gut barrier function with increased butyrate production (30).
Butyrate is the most-researched SCFA in the medical literature.
Diabetic Benefits from SCFAs
The one thing that may get my reader’s attention are the numerous associations SCFAs have in helping those with diabetes.
How?
The fermentable fibers I reviewed are also considered prebiotics. Fermentable foods (shown below) can also be known as probiotics.
Given its prebiotic perks and potential non-increasing effect on blood sugars, resistant starch has also been shown to lower A1c levels, post-prandial (post-meal) blood glucose, and increase insulin sensitivity (31, 32, 33, 34).
One study looked at the relationship among type 1 diabetic children, their gut microbiome, and their blood sugars (35).
Researchers did see a significant reduction in beneficial microbes among type 1 diabetic children compared to healthy controls.
They suggest that microbiome improvements may assist in predicting not only T1D development but may also help in blood glucose management.
Another study proposes that increased SCFA production may even be able to prevent type 1 diabetes (36).
While another study shows an association between butyrate intake and T1D prevention in rats (37).
All of these associations form a hypothesis in one study that suggests improved gut-glucose-brain energy balance.
How?
When SCFA numbers are sufficient in the body, it’s suggested to improve intestinal gluconeogenesis (glucose production) communication with the brain, increase sensitive hunger signaling, and improve overall blood glucose balance (38).
Another mouse study suggests that early butyrate intake is able to slow down the progression of high blood sugars and increase immune tolerance to reduce type 1 diabetes progression, as well (39).
It has been properly implied that a “Perfect Storm” of gut dysbiosis, leaky gut, and decreased immune function are strongly related to being seen before type 1 diabetes diagnosis (40).
SCFAs have also been seen to help strengthen the tight junctions along the intestinal wall (41).
Proper tight junction function allows for more compliance of beneficial nutrients and minerals to be absorbed while keeping problematic material out from causing problems.
There’s also a strong association between SCFAs and reduced cardiovascular disease risk, which happens to be the #1 killer among type 1 diabetics (42, 43).
HEADS UP!
If you have a blood sugar disorder, you will need to consult with your healthcare provider before moving forward with any of these potential dietary transitions.
Here’s why:
The trend in the medical literature suggests that once autoimmunity begins in the body, the next most influential variable that typically advances type 1 diabetes development is diet.
Fermentable fibers and foods all typically have an immense impact on promoting a thriving gut, which is then associated with blood sugar and metabolic health benefits (blood pressure, cholesterol, body weight), and improved insulin sensitivity (44, 45, 46, 47, 48).
We now know the gut’s functions, its importance to our immune system, and the foods that help support it.
In part 3 of this series, you’re going to learn how over-the-counter (OTC) medications and stress influence gut and immune dysfunction, and its influence on type 1 diabetes.
Summary
- The most common influencers of gut dysbiosis are:
- Diet
- Chronic use of over-the-counter medication
- Chronic stress
- Chronic infections
- Lack of physical activity
- Genetic triggers
- Environmental triggers
- Soluble and fermentable fibers and foods promote a healthy gut microbiome. Unfortunately, the Standard American Diet limits the amount of fiber consumed daily.
- Fermentable fibers cause the production of:
- Beneficial gut microbes, specifically Bifidobacterium & Lactobacillus
- Short-chain fatty acids, which promote insulin sensitivity, feed your gut microbes, & aid with weight regulation
- More acidic levels in your colon, which make it more hospitable for your good gut bugs & less inviting for the bad gut bugs
- Improved gut barrier & immune function
- Expect the following when supplementing with soluble fibers.
- Once mixed in water & ingested, it reacts as a gel-like substance that coats your digestive tract.
- This “coating” effect helps to limit glucose spikes after a meal. This, again, is why it’s encouraged to eat plenty of fiber before eating carbs to limit the number of potential glucose spikes that may occur after a meal.
- Resistant starch is an insoluble fiber that cannot be digested. Once it reaches the colon, it feeds the gut microbes present there, like Bifidobacterium and Lactobacillus. It also increases SCFA production.
- A big flaw of a low-carb diet is that it generally limits one’s exposure to beneficial fibers due to their commonly high-carb content.
- A consistent solution is supplementing with some of the soluble fibers listed in this post, as they shouldn’t spike your blood glucose levels.
- You are strongly encouraged to speak with your physician before consuming these supplements.
- Prebiotics & probiotics are extremely helpful for gut health
- Probiotics have been commonly referred to as the actual beneficial gut microbes that cannot grow in numbers without
- Prebiotics: these feed the gut microbes and allow them to grow in numbers. Without prebiotics, soluble fibers, and/or resistant starch, probiotics can’t multiply as well.
- Consuming both of these is helpful when addressing gut health with your physician.
References
- https://www.dailymail.co.uk/sciencetech/article-9241789/50-000-year-old-Neanderthal-poop-shows-weve-similar-gut-microbiomes-700-000-years.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817492/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723551/
- https://science.sciencemag.org/content/357/6353/802
- https://www.nature.com/articles/1600389.pdf?origin=ppub
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835660/
- https://www.ewg.org/foodscores/content/natural-vs-artificial-flavors/
- https://pubmed.ncbi.nlm.nih.gov/33940221/
- https://www.sciencedirect.com/science/article/abs/pii/S2212619815000091
- Partially hydrolysed guar gum (PHGG,fatty acid (SCFA) production.
- https://ffhdj.com/index.php/ffhd/article/view/325
- https://academic.oup.com/ajcn/article/70/4/466/4729069
- https://www.karger.com/Article/Fulltext/477386
- https://pubmed.ncbi.nlm.nih.gov/27357127/
- https://pubmed.ncbi.nlm.nih.gov/24388214/
- https://onlinelibrary.wiley.com/doi/abs/10.1002/jsfa.6966
- https://pubmed.ncbi.nlm.nih.gov/25966755/
- https://dom-pubs.onlinelibrary.wiley.com/doi/abs/10.1111/dom.14390
- Management of Type 1 Diabetes With a Very Low?
- Food Order Has a Significant Impact on
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801078/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390821/
- Mechanistically low and high molecular and butyrate.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004267/
- https://pubmed.ncbi.nlm.nih.gov/19383551/
- Bacteria that ferment fibers and metabolites in maintaining intestinal homeostasis.
- https://pubmed.ncbi.nlm.nih.gov/24160296/
- https://pubmed.ncbi.nlm.nih.gov/30277149/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4903954/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382411/
- https://academic.oup.com/advances/article/10/4/576/5476417
- https://pubmed.ncbi.nlm.nih.gov/22954674/
- https://www.nature.com/articles/nrendo.2015.128
- https://pubmed.ncbi.nlm.nih.gov/25214711/
- https://pubmed.ncbi.nlm.nih.gov/23433344/
- https://www.nature.com/articles/ni.3730
- Sodium butyrate prevents type 1 diabetes biobreeding diabetes prone bbdp rats
- https://pubmed.ncbi.nlm.nih.gov/24969963/
- https://www.nature.com/articles/s41598-020-76109-y
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551660/
- https://www.sciencedirect.com/science/article/abs/pii/S0899900708002827
- https://pubmed.ncbi.nlm.nih.gov/30336163/
- Type 1 Diabetes Mellitus and Cardiovascular
- Beta-glucans have been tested, another approach to cure diabetes.
- Inulin is thought to share and enhance the gut environment.
- Pectins can influence the gastrointestinal or modulation of immune responses.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316541/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9003261/